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October 1, 2020 - Brief Issue 98

The Coronavirus Daily Brief is a daily news and analysis roundup edited by New America’s International Security Program and Arizona State University.

Top Headlines

Pfizer CEO Mentions October for an “Answer” about their Coronavirus Vaccine Candidate but Emergency Use Approval is Unlikely Until November at the Earliest; Moderna’s Vaccine Candidate Elicits Strong Antibody Response in People over Age 56; FDA Requesting More Information from AstraZeneca (Health & Science)

Remdesivir, While Not a Cure for COVID-19, Is On Track to Make Billions for Gilead (Health & Science)

A Few Weeks into College Students’ Return, Confirmed Coronavirus Cases Rise by 55 Percent in Young Adults (Health & Science)

Rio De Janeiro Grieves Suspended Carnival (Around the World)

Madrid Rejects Spanish Government’s Anti-Outbreak Plan (Around the World)

COVID-19 Overwhelms Moscow’s Hospitals As Pandemic Returns in Full Force (Around the World)

Northern Ireland Sees Four Days of Record New Cases (Around the World)

India’s Caseload May Have Already Topped 60 Million (Around the World)

Indonesia Concludes Toughest Pandemic Month Yet (Around the World)

Jordan Could Return to Lockdown As Country Sees Record Daily Case Rise (Around the World)

White House Blocks Renewal of CDC “No Sail” Order for Cruise Ships (U.S. Government & Politics)

Washington Post: COVID-19 Recession Most Unequal in Modern American History (U.S. Economy)

Potential for Assets Bubbles Sparks Concern Over Federal Reserve Interest Rate Promises (U.S. Economy)

NFL Postpones Tennessee Titans Game Amid Growing COVID-19 Outbreak (U.S. Society)

Health & Science

There have been 7,234,258 coronavirus cases in the United States, and 206,963 people have died (Johns Hopkins). Around 2,840,688 people have recovered, and the United States has conducted 103,939,667 tests. Worldwide, there have been 33,997,825 confirmed cases of coronavirus, with 1,014,588 deaths. At least 23,662,200 people have recovered from the virus. 

Pfizer CEO Mentions October for an “Answer” about their Coronavirus Vaccine Candidate but Emergency Use Approval is Unlikely Until November at the Earliest; Moderna’s Vaccine Candidate Elicits Strong Antibody Response in People over Age 56; FDA Requesting More Information from AstraZeneca

Alone out of the pharmaceutical CEOs who have coronavirus vaccines in trials, Pfizer CEO Albert Bourla mentions the possibility of having an “answer” by the end of October. The CEOs of AstraZeneca and Moderna are far more vague, pointing to the end of the year. Bourla’s statements about October align with President Trump’s goals to have a vaccine by Election Day, November 3, and Trump has called Bourla a “great guy” (NYT).

“There’s a huge financial advantage to being first out of the gate,” said Megan Ranney, an associate professor of emergency medicine and public health at Brown University, and one of 60 public health officials to sign a letter to Pfizer urging it not to rush its vaccine (NYT). “What I worry about is that the politics or the financial gain may drive earlier release than is scientifically appropriate.” Pfizer has not taken federal money to develop its vaccine, instead signing a $1.95 billion deal to sell the first million doses of its vaccine to the U.S. government, and leaving itself free to price the vaccines after that. 

Pfizer’s vaccine trial is speedier than Moderna’s: Pfizer is giving its two-shot vaccine on day 1 and day 21, and starts looking for signs of illness one week later, whereas Moderna gives its vaccine on day 1 and day 28, and looks for signs of illness two weeks after that. Unlike Moderna’s trial, which is only in the United States, Pfizer’s trial is international and will take place in Brazil, Turkey, and Argentina, in addition to the U.S. In Argentina, 33,000 volunteers signed up for about 4,500 slots. “We have a lot of years of experience in these kinds of trials, and we’ve never seen these numbers before,” said Fernando Polack, the head researcher of the Pfizer study at the Hospital Military Central in Buenos Aires. Pfizer said that 24,000 volunteers across all its trial sites have now received the second dose of the vaccine, which is more than half of the expected 44,000. However, despite the speed of the trial, a Pfizer spokesperson has said that Pfizer will not be close to completing its clinical trial in October and that Bourla’s reference to a “conclusive readout” referred to the possibility that there would be promising signs that the vaccine works.

The FDA has said that they will need to track at least half of the patients for two months before granting emergency use authorization, which would push the earliest possible date into November. The side effects were mild or moderate, and included fatigue, chills, headache, myalgia, and pain at the injection site

In other vaccine news, there is encouraging information from a Phase I study. Older people injected with Moderna’s vaccine developed high levels of antibodies, similar to the levels in control group participants who had recovered from COVID-19 (Nature, NEJM, Reuters). Moderna’s Phase III trial with 30,000 participants is ongoing.

The FDA has also expanded its investigation into AstraZeneca’s large Phase III trial, which has been on hold in the U.S. since September 6 when a trial participant developed neurological symptoms consistent with transverse myelitis, a rare spinal disorder. The FDA will look at data from earlier trials of similar vaccines developed by the same scientists, said three sources familiar with the details (Reuters). The FDA has requested the information, which is expected to arrive later this week, and then the FDA will need time to review it, adding to the delays. Regulatory agencies have already given the green light for AstraZeneca to continue its trials in the U.K, Brazil, India, and South Africa. Bonus Reads: “Pfizer CEO on the Pressures of Creating a Covid-19 Vaccine: ‘What Is at Stake Is Beyond Imagination,’” (WaPo); “On the Road with Operation Warp Speed, the U.S. COVID-19 Vaccine Effort,” (Science).

Remdesivir, While Not a Cure for COVID-19, Is On Track to Make Billions for Gilead

At the moment, there is no silver bullet to treat COVID-19, and doctors are relying on remdesivir, which was shown to shorten the number of days in hospital from about 15 days to about 11, and dexamethasone, an inexpensive steroid which reduces death in patients on ventilators by a third (WaPo).

Although the U.S. Food and Drug Administration (FDA) updated the authorization to allow remdesivir to be used for any hospitalized patient, Massachusetts General Hospital is still limiting it to those who need oxygen, said Mark Siedner, an infectious-disease clinician and researcher at Mass General. Many hospitalized patients do not need oxygen, are likely to get better without remdesivir, and are discharged within five days, he said. For patients who receive remdesivir and the coronavirus continues to progress, they will then receive dexamethasone.

"It’s hard when you’re on the front line, knowing whether it makes a difference. People are not jumping out of bed and saying, ‘Thanks, you saved my life,'" said J. Randall Curtis, a doctor at Seattle’s Harborview Medical Center. He gives remdesivir to his seriously ill coronavirus patients, but from the bedside, he says the benefits of the drug are undetectable. "We are continuing to use it, because if you look at all the data in total, there probably is some benefit.”

Some are questioning whether Gilead’s price of $3,120 per 5-day course of treatment is justified, based on its modest benefits and the fact that Gilead developed remdesivir with at least $70 million from U.S. taxpayers. A Credit Suisse analyst who is tracking the drug’s progress estimated up to $4.5 billion in sales in 2020 and up to $5 billion in 2021. The U.S. government will end its control of distribution after September 30, and the drug will go out in normal distribution channels.

“The bottom line is that clinical data demonstrate that patients taking Veklury (remdesivir) recover four days faster than those taking placebo, and Veklury costs less than a one-day hospital stay, resulting in immediate savings to the health care system,” wrote Gilead spokesman Chris Ridley in an email.

Convalescent plasma is the only other authorized treatment, one that President Trump pushed for and then overstated its benefits. "We don’t know if we are conferring benefit onto patients by giving them convalescent plasma,” said Claudia Cohn, director of the Blood Bank Laboratory at the University of Minnesota Medical Center, which only provides plasma to patients if they are part of a clinical trial. Bonus Reads: “These Laboratory-made Antibodies are a Best Bet for a Coronavirus Treatment, But There Won’t be Enough,” (WaPo); “Ski, Party, Seed a Pandemic: The Travel Rules that Let COVID-19 Take Flight,” (NYT).

A Few Weeks into College Students’ Return, Confirmed Coronavirus Cases Rise by 55 Percent in Young Adults 

Confirmed coronavirus cases in people aged 18 to 22 rose 55 percent between August 2 and September 5, with the biggest spikes in the Northeast (144 percent increase) and the Midwest (124 percent increase), according to a study by the U.S. Centers for Disease Control and Prevention (CDC) published Tuesday (CNN, NPR, WaPo, WSJ). The authors say that it is “likely that some of this increase is linked to resumption of in-person attendance at some colleges and universities” (CDC). Increased testing is not the main driver of the increased numbers, say the authors. Although young people are less likely to develop severe cases, they can also spread it to others. Among young adults attending colleges and universities, 33 percent live with a parent.

A second CDC report also published Tuesday examines the case of an unnamed university in North Carolina and found that within two weeks of opening, the number of positive coronavirus tests had increased rapidly, with 18 clusters; 30 percent of cases were linked to a cluster (CDC). The school had opened on August 3; by August 19, all classes were online and the school was taking steps to reduce on-campus housing (CIDRAP). While the CDC did not name the university, school officials confirmed to the Post that it was UNC-Chapel Hill.

“This does not mean that colleges and universities can’t open for in-person instruction,” said Ashish Jha, dean of Brown University’s School of Public Health (WSJ). But schools need to implement measures that lower transmission. Brown University is testing its students twice a week, which Jha said is the kind of surveillance needed to identify infected students who aren't showing symptoms before they can spread the virus widely. 

Colleges are using targeted lockdowns and remote classes to slow the spread of coronavirus. Providence College put itself on lockdown, with classes online; students could socialize only with their roommates. The University of Arizona asked students to shelter in place for two weeks. The University of Wisconsin-Madison and University of Colorado Boulder quarantined thousands of students and moved classes online. “This may be the last opportunity for our campus to bend the curve of infection and return to in-person instruction before we are forced to move to remote operations for the remainder of the semester,” Colorado Chancellor Philip DiStefano said in a note to the school (WSJ). “Let’s prove we can do this.”

Some colleges have shown that these actions are effective. The University of Notre Dame found 19 percent of the day’s tests came back positive, about a week after classes started. The university switched to online instruction, barred visitors from the dorms, and limited gatherings to a maximum of 10 people. After two weeks, just a few tests were coming back positive. 

U.S. Hospitals Still Do Not Have the Information They Need to Handle COVID-19 Surges

In the United States today, there is still “no viable way to broadly track what’s happening inside hospitals” in terms of available beds, ventilators, and other other critical supplies, writes the Wall Street Journal. This information is critical to managing a surge in the pandemic, and many hospitals and cities are readying themselves for surging numbers in the months to come. “The U.S. has tried – and failed – over the past 15 years to build a system to share such information in a crisis,” writes the Journal. “When the pandemic started, nothing like it existed.” 

During a surge, patients may wait for hours before being transferred to a hospital with a bed for them, as Jose Manuel Abundis Gomez found out in El Centro Regional Medical Center in California. He waited in the emergency room for 20 hours and his oxygen levels went down; after his transfer, he died. During the coronavirus surge in California, the “state is averaging 40 phone calls to place just one of these COVID patients in need,” Carmela Coyle, president of California’s hospital association, wrote in her plea to executives asking which facilities had open beds.

Weeks after the coronavirus appeared, various administration officials began to work on putting together a solution. The U.S. Centers for Disease Control and Prevention (CDC) added COVID-19 questions to its existing hospital surveillance system, which about 6,000 hospitals already used. An official from the Department of Health and Human Services (HHS) emailed the White House to say that the established CDC system would be more successful than HHS starting one from scratch. However, HHS moved ahead with a separate hospital data reporting system and granted a contract to TeleTracking Technologies. 

In late June, as Covid-19 cases surged across the South and West, White House coronavirus coordinator Deborah Birx told health-care industry executives on a call that it is easier to get data from HIV clinics in Africa than U.S. hospital data, according to people familiar with the call.

In July, a letter signed by HHS Secretary Alex Azar and Deborah Birx said that all hospitals must submit their data through TeleTracking, unless states submitted on hospitals’ behalf, and the CDC would stop accepting data as of July 15. Hospitals that weren’t already reporting to TeleTracking had days to make the switch, but not all of them did.

The move from one system to another created more risk for errors, said public health and industry experts. In August, Birx told hospital executives of plans to move the system back to the CDC. In September, the CDC wrote a review that found a number of errors in hospital data since the change of systems: one hospital reported 15,000 beds, for example, while another said it had a negative number of beds occupied.

Around the World

The Americas

Rio De Janeiro Grieves Suspended Carnival

Residents of Rio De Janeiro are grieving the first suspension of the annual Rio Carnival parade in more than a century. While the planned February 2021 event is technically under indefinite postponement, any attempt at recreating the parade later in the year will not occur in time to mark the beginning of Lent, the impetus behind the festival. “I feel like crying, seeing they haven’t started the work of building the floats,” said Nicilda da Silva, 80, who was to serve as the queen of the Porto da Pedra samba group in the parade. Leandro Vieira, the artistic director of the Estação Primeira de Mangueira samba group, said that the catharsis usually provided by the massive, multi-day street party will be sorely missed in light of the difficult times. “I want this moment to come, this moment when we will celebrate life that defeats death, when we will reunite, gather, but this moment is not possible yet,” he said. Rio De Janeiro has been one of the world’s hardest-hit cities by the pandemic. More than 18,000 residents have died from COVID-19 in a city of 16 million (NYT).

Europe

Madrid Rejects Spanish Government’s Anti-Outbreak Plan

Madrid city leaders have rejected the central government’s plan to curtail the spread of the coronavirus as the Spanish capital faces the fastest-growing outbreak currently in Europe. With an infection rate of 784 cases per 100,000 people, spread of the virus in Madrid’s is 2.5 times the national average and seven times the European average. Under the new rules approved by most Spanish regions, the current scale of Madrid’s outbreak would trigger the cordoning off of the city’s most-impacted neighborhoods, with residents only allowed to leave the hot zones for essential business, in a policy that the government has termed “selective confinement.” But in defiance of the left-wing coalition currently running the country, the city’s center-right government insists that the spread of the virus in Madrid is under control. “The situation is controlled. We have always anticipated the hospital capacity to contain this pandemic, and we’ve had several days for which the balance between discharges and admissions is favorable,” said regional health chief Enrique Ruiz Escudero, adding that the “the government is in a hurry to lock Madrid down.” Galicia, Catalonia and Andalusia regions also rejected the proposal along with the exclave city of Ceuta in northern Africa, although none have met the severity threshold that would trigger selective confinement (El Pais, AP).

COVID-19 Overwhelms Moscow’s Hospitals As Pandemic Returns in Full Force

Frontline health workers in Moscow report an unprecedented onslaught of work as infections in the Russian capital return to levels not seen since May. “Right now I’m working twice as hard as I did in the spring,” said Milena Berulava, a 22-year-old nurse in the capital’s Kommunarka district, adding that two nurses must now care for 40 patients compared to 12-15 patients in the spring. Alexander Vanyukov, a surgeon at Clinical Hospital No. 52, told the Moscow Times on Monday night that all 900 beds were filled in his COVID-19 ward. Seven new hospitals began admitting COVID-19 patients last week, bringing the total number to 22. Three field hospitals from last spring have also been “reactivated,” reported the Interfax news agency citing a source from city hall (Moscow Times). Moscow, the epicenter of Russia’s outbreak, reported 2,300 new cases on Tuesday, its highest level since May 31. Mayor Sergei Sobyanin announced on Tuesday that a week-long school break planned to begin on October 5 will be doubled to two weeks to help stem new infections. Russia, the fourth-most infected country in the world, has recorded a total of 33.8 million cases since the pandemic’s beginning (RFE/RL).

Bonus Reads: “Ending the Nightmare: A ‘Meduza’ Special Correspondent Joins Russia’s Coronavirus Vaccine Clinical Trials and Catalogs the Experience Before and After Her Shot,” (Meduza); “‘Mushrooms Have Kidnapped You’: Pandemic Feeds Russia’s Obsession With Forest Fungi,” (WSJ).

Northern Ireland Sees Four Days of Record New Cases

Northern Ireland tallied a record number of new cases on Wednesday for the fourth time in the previous six days. The U.K.’s smallest nation recorded 424 new infections, slightly less than the Republic of Ireland’s 429 cases despite having just a third of the population size. The most-impacted area was the Derry City and Strabane district near the border, which had an infection rate of 323 per 100,000 people in the last seven days. Robin Swann, Northern Ireland’s health minister, said that new restrictions were “inevitable” for Derry City and Strabane, adding he is “more concerned about what lies ahead” now than at any other point in the pandemic. He did not rule out more region-wide restrictions ahead of an executive meeting planned for Thursday. “Those conversations will happen tomorrow and we will have to decide what new restrictions apply and whether they are NI-wide, or whether they are more localized,” said Swann (BBC).

Asia-Pacific

India’s Caseload May Have Already Topped 60 Million

India may have already experienced more than 60 million coronavirus infections, roughly ten times the official count, according to the nation’s lead pandemic agency. While India has officially recorded more than 6.2 million cases, antibody tests conducted by a government study in 21 states and territories suggest a far greater rate of infection. “The main conclusions from this sero survey are that one in 15 individuals aged more than 10 have been exposed to SARS-CoV-2 by August,” said Balram Bhargava, Indian Council of Medical Research (ICMR) Director General, at a health ministry press conference. The virus appeared particularly prevalent in urban slums, with 15.6 percent of those tested having antibodies. In contrast, urbanites living outside slums tested positive for antibodies at a rate of 8.2 percent while those in rural areas tested positive at a rate of 4.4 percent (AFP).

As we have noted before, experts have long suspected that India’s official case count is a vast underestimate owing to little testing and shoddy bureaucratic record-keeping in vast swathes of the country. Community medicine specialist Dr. Hemant Shewade pointed out in an interview with CNN in September that only 22 percent of all registered deaths in the country listed a cause even before the pandemic. He also stated that only 63 percent of deaths were even registered in the first place in Delhi in more normal times, while the majority of fatalities in the countryside never make it into official data (CNN).

Bonus Read: “Huge Study of Coronavirus Cases in India Offers Some Surprises to Scientists,” (NYT).

Indonesia Concludes Toughest Pandemic Month Yet

September was Indonesia’s worst month since the start of the pandemic, with more cases and deaths from the coronavirus reported than in any previous month. The country’s 112,212 new cases marked a 69 percent rise since the end of August, while its death toll of 3,323 represented a 45 percent increase. Jakarta led the total case count, with 33,650 cases representing 30 percent of September’s new infections. The city has been under lockdown since mid-September after the capital’s governor warned that the health care system was on the brink of collapse. While provinces on the island of Java, home to Jakarta, continued to lead the way in new cases, new hotspots have emerged in the provinces of East Kalimantan, Bali, Riau, West Sumatra and Aceh (Jakarta Globe).

Middle East

Jordan Could Return to Lockdown As Country Sees Record Daily Case Rise

The Jordanian government warned that the nation may return to full lockdown as the country experienced its largest daily case rise on Wednesday since the pandemic’s start. After a quiet start to the pandemic that lasted through the summer, Jordan began seeing daily case counts rise into the triple digits in September. New cases doubled last week before crossing the 1,000 mark for the first time on Wednesday with 1,767 new infections. New restrictions introduced last month are due to expire on Thursday, with mosques and churches set to reopen along with restaurants. School closures, however, have been extended. The Baqaa Palestinian refugee camp on the outskirts of Amman will also be locked down on Thursday to curb the virus’ spread. Government spokesman Amjad Adailah said on Wednesday that more measures, including full lockdown, could be implemented if the situation continues to deteriorate despite potentially devastating economic consequences. “This is a matter that no one wants,” he said, referring to the drastically rising case count (Reuters).

U.S. Government & Politics

White House Blocks Renewal of CDC “No Sail” Order for Cruise Ships

The White House has blocked a planned CDC renewal of the order forbidding cruise ships from setting sail, which was set to expire on Wednesday (NYT). CDC Director Dr. Robert Redfield had recommended renewal at a meeting of the White House Coronavirus Task Force on Tuesday, but was overruled, according to the New York Times. The Trump administration plans to let cruise ships sail again starting on October 31. The decision comes as Florida’s cruise ship industry and its Republican Senators Rick Scott and Marco Rubio have pushed for a reopening. The decision also comes following clashes between the CDC and the administration and allegations of improper political interference in CDC products on the part of political appointees. The Times notes, “According to the CDC there were 2,973 of cruise-related cases of Covid-19 or Covid-like illness, and 34 deaths, from March 1 through July 10.”

Bonus Read: “Trump’s Debate Highlights his Hunger for a Rushed, Election-Eve Vaccine Approval,” (STAT).

U.S. Economy

Bonus Read: “Pandemic Convinces Airline Workers It’s Time for New Horizons,” (NYT).

Washington Post: COVID-19 Recession Most Unequal in Modern American History

The recession sparked by the coronavirus pandemic is the most unequally borne one in modern American history, according to an analysis of employment data Wednesday in the Washington Post (WaPo). According to the Post, the percentage of Americans lacking employment fell to its lowest level since 1975, recovering to levels similar to that during the 2008 Great Recession in August. However, according to the Post, “Hispanic Americans saw the steepest initial employment losses and still have the most ground to make up to reach pre-pandemic employment.” Meanwhile Black Americans have only recovered about a third of their employment losses while white Americans have recovered about half so far. Young people have been disproportionately impacted compared to older people and mothers compared to fathers. Mothers with young children were particularly hard hit. The Post writes, “Recessions often hit poorer households harder, but this one is doing so at a scale that is the worst in generations, the analysis shows.” The Post notes, “White women, for example, have recovered 61 percent of the jobs they lost — the most of any demographic group — while Black women have recovered only 34 percent, according to Labor Department data through August. And workers with college degrees are 55 percent recovered, compared with less than 40 percent for workers with high school degrees.” Ben Bernanke, who led the Federal Reserve during the last recession told the Post, “It’s an even more unequal recession than usual.” Bonus Read: “How the Coronavirus Crisis Threatens to Set Back Women’s Careers,” (WSJ).

Potential for Assets Bubbles Sparks Concern Over Federal Reserve Interest Rate Promises

Fear of a potential asset bubble once the pandemic begins to wane is sparking concern both within and outside the Federal Reserve over its promise to maintain interest rates at near zero levels as a result of the pandemic, according to a report in the Wall Street Journal on Wednesday (WSJ). The Journal writes, “Those concerns flared when Dallas Fed President Robert Kaplan dissented from the central bank’s September 16 decision to spell out those promises. The Fed committed to hold short-term rates near zero until inflation reaches 2 percent and is likely to stay somewhat above that level—something most officials don’t see happening in the next three years.” Kaplan told the Journal, “There are costs to keeping rates at zero for a prolonged period” adding that such a promise, “causes people to take more risk in that they know it’s much less likely that they’re going to be able to earn on savings.” The Journal notes that the “September 16 rate guidance alluded obliquely to financial bubbles by saying officials would adjust their current lower-for-longer policy stance ‘if risks emerge that could impede the attainment of the committee’s goals.’” Boston Fed President Eric Rosengren, who does not currently have a vote on the committee tasked with rate setting, told the Journal, “I share a lot of Rob’s concerns.”

U.S. Society

NFL Postpones Tennessee Titans Game Amid Growing COVID-19 Outbreak

The NFL has postponed a game between the Tennessee Titans scheduled for Sunday against the Pittsburgh Steelers amid a growing outbreak among the team’s players and staff (WSJ). The team suspended its activities on Tuesday following positive tests for three players and five staff members. The Minnesota Vikings, who played the Titans last Sunday have not reported any positive tests. On Wednesday, Troy Vincent, the NFL’s Executive Vice President for Football Operations, wrote in a memo to teams, “If we are to play a full and uninterrupted season, we all must remain committed to our efforts to mitigate the risk of transmission of the virus.”

Analysis & Arguments

Zeynep Turfecki discusses the overlooked variable of k, a measure of the dispersion of the virus, in coverage of the pandemic (Atlantic).

Sam Anderson writes on life inside the NBA’s coronavirus bubble (NYT).

Elisabeth Rosenthal writes on the need to enforce mask mandates (NYT).

Seven former FDA commissioners warn about the dangers of the White House attempting to influence the FDA’s vaccine approval process (WaPo).

Jessica Suriano looks at Arizona’s coronavirus experience and argues libertarian political ideology played a role in shaping the state’s failures (Nation).

 Readers can send in tips, critiques, questions, and suggestions to coronavirusbrief@newamerica.org.

The Brief is edited by David Sterman and Narisara Murray and co-edited by Emily Schneider and Bennett Murray with Senior Editor Peter Bergen.

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